Category Archives: Digital India

Beyond Ridiculous!

Beyond Ridiculous!
© Dr. Rajas Deshpande

A 9 year old child with fits / seizures was taken to a renowned Paediatric Neurologist. He started treatment with one of the most commonly recommended (by almost all textbooks) used medicine in the treatment of seizures: carbamazepine. One of the most effective medicine, used since over 50 years in children, that can cause side effects of rashes in less than 1/1000 cases. Still rarely, the side effects can be very severe, causing extensive damage to the skin.
The doctor explained this to the child’s parents, and then started the recommended doses. Pediatric doctors are the best trained doctors in dose calculation, they are more aware than any other specialty about the side effects in general, because children often cannot even speak and parents may not notice some side effects. © Dr. Rajas Deshpande

Every medicine has side effects. Even vitamins do. Any medicine can potentially cause life threatening reaction, and that’s why the common warning with each medicine: do not use if you are sensitive to this medicine. How will one know whether there will be any allergy / reaction to the medicine without having used it?

Most medicines can cause side effects at high doses, but some can cause dangerous reactions even with the tiniest dose, or test dose. Some medicines (even the one mentioned above) can cause side effects after many months / years of safe use. While the dose dependent (high dose= higher side effect) side effects are somewhat predictable, the ‘idiosyncratic’ (meaning occurring in individual, not all cases, because of the natural tendency of that person) and “allergic” side effects are totally unpredictable, and can be caused by even such common medicines as paracetamol, aspirin, antibiotics or vitamins. Even deaths have been reported after the use of some common medicines, but even in the highly legalized western world, no court holds doctors guilty for the side effects of medicines, if these were discussed and informed to the patient / family. This is against common sense. © Dr. Rajas Deshpande

This child unfortunately developed a rare but well known side effect of this drug, called Stevens Johnson Syndrome (severe skin rashes), had to be admitted and treated, it cost them one lac rupees. While we sympathise with the child and the family, and wish them the best recovery and health, this is hardly the mistake of a doctor.
But the forum, in a regressive decision, held the doctor guilty, fined him 90000 rupees. This is beyond ridiculous. The court observed that “ if the doctor knew that this drug can cause side effects, he should not have prescribed it”. Translated intellectually, that means NO DOCTOR CAN PRESCRIBE ANY MEDICINE! © Dr. Rajas Deshpande

Moreover, what will this court advise for the child now? Every seizure medicine has some rare dangerous side effects. There are no medicines free of side effects. Shall the child be left without treatment now? Which doctor will want to treat such a case? Which court will guarantee that the rarest of the rare side effect cannot happen again in this case, and with such ill-informed forums, the next doctor trying to do good to the child will not be held guilty? © Dr. Rajas Deshpande

Technically, if using a drug that can cause side effects is a crime as per this court, it should hold everyone concerned guilty: the textbooks / medical bodies that recommend this drug, the pharma which produced it, and even the government which allowed it to be sold. Applying the same logic, if some child developed peanut allergy in a hotel or side effects of pollution and dust by travelling on Bangalore roads, will this court hold the hotelier or the city administration guilty and punish them too? Has this forum/ court banned tobacco and alcohol yet, or will it punish the government for the side effects and thousands of deaths caused by these? © Dr. Rajas Deshpande

The IMA, other medical bodies, Neurological society, and intellectuals should stand by this doctor who has suffered the mental agony. This decision must be challenged in higher courts.
We regret that some patients suffer side effects, no one should, but at the same time, the “side effects of medicine” is not the doctor’s fault, especially in this case where he had explained the parents about such possibility.
We need medically educated forums and judges who can refrain from populist tendencies.
© Dr. Rajas Deshpande
PS:
I respect courts. I respect higher courts more. But I refuse to believe that every decision made by every judge is correct, that every decision is impartial, that it is not affected by pressures. This article is solely based upon the attached news clip. I must admit that this reporter Ms. Meghna Singhania has done an excellent and impartial reporting. Doctors must please stand united against this decision.

https://medicaldialogues.in/side-effects-of-prescribed-m…/…/

Dictatorial Actions?

Dictatorial Actions?
© Dr. Rajas Deshpande

If one minister commits a mistake, does the entire government go?

Even the wrong ministers rarely go.
If one doctor / department has committed a mistake, how fair is it to cancel the license of an entire super-specialty hospital, where over a hundred specialists work, many hundred patients are already admitted and many thousand patients follow up for their regular treatment? What about those who had planned major surgeries and treatments there?

There indeed was a grave mistake. The relatives have suffered an immeasurable loss, and this must be investigated and the guilty must be brought to justice. Every doctor feels sympathy for every life lost. This is a science and practice of life where human mistakes are not impossible, they should be scrupulously avoided. If however they do occur, one must not overreact, especially for populist advantages. © Dr. Rajas Deshpande

Whether it was one person or an entire team that was wrong, they must be tried. But how fair is the action of closing down the entire hospital? Is this not affecting the basic human rights of the other patients, doctors and staff working there?

Is this a good tradition to follow in a country with an already collapsed government healthcare system? Someone has lapsed. Who made the hospital protocols? Who implemented them? Were they followed? Who issued the hospital license without confirming standards? If license was issued that means some standards were defined. If not, why was the license issued in the first place? If these standards were defined, it is easy to find out who was at fault, and take action accordingly. © Dr. Rajas Deshpande

It is well known that corporate / majorhospitals have to pay hefty bribes almost everywhere to get every permission. They are business houses promoted by an administration that cannot deal with the country’s healthcare overload. That is also a reason why some hospitals / teams may not follow standard protocols, and confidently overbill the patients. Why doesn’t the government define the limits of profits on commodities rather than capping doctor’s fees? The answers are simpler to the wise. © Dr. Rajas Deshpande

What about the many other good doctors who worked at this hospital, who had joined there as a career, who had bought homes nearby to reach the hospital faster? What about the students who had joined there as post graduates in various specialties? What about the staff?

Was it impossible to hand over the charge to some doctor’s body / organisation or under a competent authority for better running rather than closing down the hospital? The correct action then should have been suspension of the involved department / team till the facts were found out, and after medical and legal opinions, trial as per law. This is what every minister, every administrator, every TDH of any significance demands and gets as a basic right even after grave crimes. © Dr. Rajas Deshpande

There was of course a basic investigation. Why not exactly find out and take strict action against the medical / non medical administrators or owners involved? Add to this the apathy shown by medical bodies and other hospitals in this case.

Welcome to this glimpse of future that will be commonplace for all hospitals if no one acts now. Populist headlines will never solve the grave healthcare that deficits India faces.
© Dr. Rajas Deshpande

My sympathies, as those of every good doctor in India, lie with the relatives who have suffered. They must get justice.But that should not be at the cost of destroying the careers of many other medical and non medical people who were not guilty

© Dr. Rajas Deshpande

The Business Of Medical Bargain

The Business Of Medical Bargain
© Dr. Rajas Deshpande

“I will die now” the forty-plus gentleman said in a semi-threatening way, “I haven’t slept all night yesterday as I was with my brother, I even skipped my lunch today. I must sleep now. I will leave my cell number, if something happens to my brother, they can call me. You are around, right?”

“Yes, the ICU team is looking after your brother round the clock, I am around till late night.” I told him. There was no point in telling him that I hadn’t slept for last three nights either.

On the prior night at about 10.15 PM, after my work hours, as I went to receive my sister on the airport, I had received his panic call, as this gentleman’s brother had developed sudden convulsions. This brother had seen me few months ago, in emergency, when he had developed a stroke. I remembered that they were quite unhappy about the bills then in spite of a good recovery. They had left with sarcastic remarks about the bills. A good memory is essential for every doctor.

I asked them to rush to the casualty, gave him the number for ambulance, and went to park my car at the airport.

“One Hundred Rupees, Sir” said the person on the parking desk.
“But I am parking only for few minutes, I have come to pick someone up” I asked him, surprised that the parking charges. © Dr. Rajas Deshpande.
“Even for entry the charge is 100 rupees” he told me with a cold smile. I had started getting calls from my sister, she had landed. I paid his hundred, parked the car and went on to receive her. On the way, I called up the casualty and issued instructions about this patient who was to arrive there.

Sis was tired, but happy to see me. I told her that we had to make a stop at the hospital on the way back, there was an emergency.
“When will you become a senior doctor who does not have to attend patients at night?” she asked with a sarcastic smile.
“Never”, I replied, “All Indian doctors die young and working.”
“Shut up, don’t talk rubbish things like that” she said with her feminine instinct. “I desperately need tea, can I get some and drink it on the way?” she asked.
We went to get tea and my coffee.
“Two hundred and fifty Rupees, Sir” said the attendant at the airport tea stall.
“Why?” I asked a stupid question almost knowing his answer, “Even an MBBS doctor charges less than your tea/ coffee”.
“GST” he replied, calmly. As if airport shops were dishing out cheap before GST!
After counting the money and safeguarding it, he gave me two sips each of tea and coffee. We also bought 500 ml drinking water for another 100 rupees, and drove to the hospital. © Dr. Rajas Deshpande

Leaving Sis in the car, I went to the casualty. The patient arrived in a few minutes, it was nearly 11 PM. He was still unconscious, convulsing and bleeding from his mouth. The casualty team got into efficient action, and in a few minutes the convulsions stopped. Writing his orders and answering many relevant and irrelevant questions asked by his irate brother, explaining him the situation and criticality, I drove Sis home well past midnight.

Three days later, he was discharged, fully recovered. Till then I received innumerable calls day and night because of their complaints ranging from blankets, food and ‘the nurse did not come immediately when I pressed the bell’, to medical management and doses etc. The patient and his brother had spent most of their life in Switzerland (restauranteers). They net-researched a lot and tested my knowledge and patience together, till the time I finally and subtly gave them an option to handover the case to a “Senior” colleague, very good but famous for not answering any questions at all. Then they stopped.

Upon discharge, the patient and the brother brought me the hospital bill. A doctor has the same control on the hospital billing that a common man has on the government, I told them so.
“The hospital bill is okay” he said, “but you have charged a thousand rupees per day. That is too much”.

“What would you charge, Sir, if you were a superspecialist with high qualifications and over 20 years of experience, rushing late night to attend an emergency?” I asked him, “What will you charge if you were to attend a person 24/7 under your care, answerable by law and having a right to sue you for lakhs if you commit simplest of a mistake?” © Dr. Rajas Deshpande

“Three Hundred rupees is the maximum I think a doctor should charge. Our family physician charges us that much since last 5 years” he said without a blink.

“Sorry Mister, we are not bargaining about this. Your family physician is gracious, but even he is charging you far less compared to the western standards of care you expect. What essentials of life have gone cheaper in last 5 years? Even the T shirt you wear is an international brand costing above two thousand rupees. Just because you are in India, you did not buy a three hundred rupees T shirt, or a local brand of car or cellphone. Indian doctors already charge far lower, being aware of the poverty status of multitudes. You must not take advantage of this and claim minimal rates for all medical services. In the western world, a specialist won’t have come for you to the casualty after his work hours, nor would you be able to reach him / her, and every consult would cost you over five times what I have charged you”.

“But Doctors should not think about money” said the patient.

I had decided long ago never to discuss money with patients. This had cost me immeasurable losses, some dupe the doctor / hospital outright, while some think a polite sweet talk is enough fees. Some bring VIPs, some threaten blatantly. © Dr. Rajas Deshpande. Even the insurance companies want every medical service to be available at a concessional rate for everyone!

God has given me enough and I am thankful. I go to work every day with an aim to return God’s favours in whatever small ways I can. However, I don’t understand the rich / affording people who take advantage of what is meant for the poor.

“Indian doctors spend only two minutes with the patient” said a recent headline, adding copious amount of fuels to the anti-doctor sentiments of the society. This is a clear equivalent of the naked pictures such newspapers publish to get attention. They conveniently forget the doctor-patient ratio in the western world, the payments for medical services, availability of specialists, waiting period for appointments, the education and behaviour of patients, non-interference by politicians, working hours and facilities for the doctors, and most importantly the fact that India provides doctors to almost every country upon earth, and gets patients from many developed countries too.
Because they know, people will buy the newspaper only if they print those naked pictures! © Dr. Rajas Deshpande

“Ok, just give us some concession” said the brothers.
“Do you ask concessions in parking lots, in coffee shops, in hotels?” I asked.
Disgruntled, he replied “No, but you are a doctor, you must be compassionate to the patient”.

“Compassionate to the patient or his greed for money and skimpiness?” I wanted to ask, but time was running short, so I wrote a note or the billing to cut off some amount from my consultation fees, and resumed work.

India needs a two-tier medical charging system, with those below poverty line getting all basic medical services free and special services at a basic cost, while all others must pay relevantly.

My businessman friend, who is also an excellent and compassionate human being was laughing at me. “You doctors let people do this to you. There is a difference between being compassionate and letting someone take advantage of you. The later is stupidity. There should be a special window for bargainers of doctor’s charges and medical bills, and the bargaining should begin at the time of admission. That is when the value of saving health and life, and the importance of timing are best felt. Once the patient improves, the value of medical service received becomes zero. If they cannot afford, give them the basic treatment for emergency and let them go to a hospital where they can afford the treatment. There are many choices. To insist on a set of specialists, luxuries and then to refuse to pay is the general tendency, you will always lose in this case”.

Almost every doctor enjoys saving lives, treating thousands to relive their suffering. However, the continuous onslaught of allegations about high fees, legal threats, mudslinging by some politicians and socially prominent influential nitwits, combined with a callous attitude by most media takes away so many proud pleasures from a doctor’s life!

© Dr. Rajas Deshpande

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PS: there are some who continuously fail to grasp the main issue and continue their age-old song about some doctors and hospitals doing too many tests, taking advantage. The simple solution is : don’t visit such doctors or hospitals. Don’t do the tests. Be happy.

What Your Doctor Never Tells You

What Your Doctor Never Tells You

© Dr. Rajas Deshpande

This small girl who had had her third convulsion in last three days was now looking frail. Her mother, extremely anxious, asked me what can be done to “immediately stop” her convulsions. This hyper-mother had stopped all the epilepsy medicines of this kid few days ago. Patiently, I asked why.

“Because I read on an article describing ‘what your doctor hides from you’, in which the author had recommended a particular diet of natural ingredients “, she replied, adding “the article said that all allopathic doctors give you medicines that will keep you sick for longer, so that they can earn more. It also said operations like joint replacements or procedures like angioplasty should never be done.”

Needless to say, this lady was buying the “Purest Natural Guilt Free” products from that website, at a price that was way costlier than all of her allopathic medicine combined.

I told her that it was a mistake to stop the kid’s medicines, and issued her a new prescription. © Dr. Rajas Deshpande

“What do you do, mam?” I asked her.

“We run a bakery, I sell exotic cakes, muffins etc.” she replied.

“Do you lie to your customers? Do you sell them products that will harm or kill them?” I asked.

“No, never! How will my business run then? We have to obtain licenses for food quality.” she retorted.

“It is the same about us doctors, mam. All the medicines, stents and joints that your article has slammed, are approved by government, and additionally, they are scientific products, not just claims. The government also earns tax on each medicine, stent or joint sold in India”.

I was offended somewhere, and so continued:

“We come from similar families as yours, mam. Even our parents teach us culture, compassion and good habits just as yours do. We doctors learn in the same schools as you, and common school teachers have taught us the importance of good. We too have parents, spouses and family, kids whom we teach good values by practice. Why will such doctors hide the truth from you and suggest you something that will harm you, who have come to us in good faith? Do you presume that all of the thousands of brilliant patriotic doctors will hide a cure from patients, and continue to let people suffer? Just because some bakery is selling rotten cakes, how would you like someone badmouthing your bakery, your integrity? ”

“Not you doctor, but not all doctors are like you” she said.

“Thank you for your faith mam, but I know that most doctors are like myself, who have struggled hard to achieve their degrees, to be able to save lives and bring an end to the suffering of millions. It is not an easy task, there are many easier ways to earn money with lesser hard work and sacrifice. You will rarely find the children of stars, sportsmen, industrialists and other ultra rich becoming doctors, no one wants so much hard work for such less money.” © Dr. Rajas Deshpande

“We cannot advertise, while most of the alternative medicine companies, gurus and babas keep on blatantly claiming cures for incurable diseases, spreading rumors about allopathy and some other recognised pathies, cleverly selling their own products to desperate patients who hope for relief, and spend far more in the wrong direction. Look at who all is earning crores while claiming that allopathic doctors are cheating people”.

She said she agreed, and won’t interfere with the right treatment of her child now onwards.

This is a complication of a deliberate and sick propaganda which has been orchestrated to tarnish the image of especially allopathic doctors, to be able to sell innocent patients one’s own unscientific products. It is sad that the very people who complain about the consultation charges of qualified doctors go and buy extremely costly “magic remedies” like some unproven, unscientific laser instruments, vibrators, garments, herbals, extracts etc. © Dr. Rajas Deshpande

The fact that vegetables and fruits are costlier than many medicines, that weekly vegetable expenses or family dinners in India are far more pricey than a specialist’s consultation which can be obtained urgently, speak a lot about where we stand. In the developed western world, there are year-long waiting lists to see most specialists. The fact that Indian doctors are the best and hardest working is appreciated all over the world, but so many Indian gurus, babas and fraudulent quacks run campaigns against our own doctors, in our own country! © Dr. Rajas Deshpande

Want to really know what the doctor doesn’t tell you?.

A doctor never tells you to go to herbal babas when you come to the emergency and need immediate attention. A doctor never asks you to take your lot to the websites that slam medical profession, when you need help. A doctor never abandons even a faithless and arrogant ignoramus, does not ask them to go search internet for blogs and natural remedies when someone is dying of a heart attack or a stroke or accident. While many recent fulminant ads claim that all doctors are greedy and deceptive, there are thousands of doctors in the hospitals all over world, who are not eating, sleeping or being with their family right now: not because they want more money, but because many will die if we don’t work hard. It is so sad that this had to be explained in India!

What a doctor really doesn’t tell you is: how difficult it is to treat and to save lives of the very people who have no faith in the one trying to do them good!

© Dr. Rajas Deshpande

PS: Recently the number of posts circulating to slam all medical professionals, especially allopaths, have increased, especially in an attempt to market certain products. This extremely harmful trend is ignored by all concerned authorities. This article is an attempt to defend the glorious scientific profession I belong to.

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The Cult of Good Blood: Superhero Medical Students

The Cult of Good Blood:
Superhero Medical Students
© Dr. Rajas Deshpande

He grew up selling vegetables and fruits grown by his mother. He went door to door and in the village market to sell those. He also walked for two miles every day to catch a bus to a school over 20 miles away. He then enrolled in a private class that waived off his fees, because he had a passion: He desperately wanted to become a doctor.

Atul Dhakne, son of a school teacher Mr. Nivruttirao Dhakne and farmer Mrs. Mandabai Dhakne, with his hard work and merit, got admission in the prestigious B.J. Medical College in Pune.

But he wasn’t satisfied. “What about those like me who are from the poor rural background, those who have no access to good classes and education, but want to become doctors?” he worried.

Good Blood speaks, whichever soul it flows in. Young medical students of different origins, studying with him, decided to resolve this. Ketan, son of a lawyer Mr. Avinash Deshmukh (who mostly handles cases for the non-affording,) wanted to do charity like his father. Farooque Faras, whose father raised a family in one small room, was burning with the desire to give. Many others joined in (names below), and the Cult of Good Blood multiplied. They all wanted to uplift the deserving.

“Lift For Upliftment” was born, formed by the superheroes among medical students.

They printed posters and went to almost all junior colleges in Pune, appealing students from poor backgrounds to join their free tuitions / classes, to prepare for the CET /NEET. In the first round, over 40 students joined. After the medical college hours, Atul and his friends took turns to teach these poor students, give them notes, set question papers, conduct exams, assess and counsel for improvement. All expenses were borne from their own puny pocket-money.

There was no fixed place for the class. One local bakery owner, Mr. Dinesh Konde, decided to help these students. He planned the logistics and took them to the corporator Mr. Avinash Shinde, who asked for only one thing in return of his help: commitment to continue this good work. The Cult agreed whole-heartedly. With him, they approached Mrs. Meenakshi Raut, Asst. Director in the education department in Pune, who helped them get two classrooms in a Municipal school after the school hours. The classes thus became regular, every day, from 6-9 PM.

The cult lacked stationery, the huge backup of notes and question paper sets for 40 students, so they approached Mr. Sanjeevkumar Sonavne from Latur, who runs many educational institutes, helps poor students, and even pays the fees of some who cannot afford college. Mr. Shelke and Dr. Harish from Sassoon Hospitals also joined hands to help.

The results were impressive: from the first such batch, 6 students qualified for MBBS, 3 for BDS, 11 for BAMS and 2 for BHMS.

No one had earned anything, but Good Blood flowed forward. Many medical students from subsequent batches came forward to teach free, imparting their fresh acquired knowledge and skills to those who could otherwise have no access to it.

There is no discrimination while accepting junior college students for their class. They have two batches now with 60 students in each. They have also started weekend classes for poor students preparing for NEET in the extremely backward area of Maharashtra, named Melghat. These medical students go to Melghat with their own expenses, teach the rural junior college students over the weekend, and return to attend the tough schedules of medical college again!

“I learned helping others from my mother. We don’t earn anything, but we learn something precious every day” tells Atul, who has now passed MBBS. Ketan Deshmukh, Abhiraj Matre and Farooque Faras help him supervise the group. Their endless enthusiasm only reminded me of how much more I can do. I came to know of this group “LFU” during the recent “Quest Medical Academy” event arranged by Dr. Sushant Shinde.

They are naturally, perpetually short of funds.
I am not rich, but I won’t feel right about myself if I didn’t contribute. They graciously accepted.

When these students came to meet me today, I offered them dinner at a good restaurant (knowing that they stay in hostels). Farooque said “Sir, we will rather use that money to print some more question paper sets”. Farooque’s father has stopped all celebrations in the family, and sends all the money he can, from his one small room home, for the torch of humanity that his son carries forward!

When they asked for an advice, I had but one small request for them: that a Doctor should be completely free of all political and religious influence at work, in teaching, and especially while treating a patient. They assured me that “Lift For Upliftment” has decided to never be affiliated to a political or religious organization, keeping humanity as their highest ideal.

There is no better lamp than the one which carries the light from soul to soul. There is no better definition of humanity than holding hands of those who need it most. I feel very happy today, that I could contribute to this beautiful, divine cause.

Long Live the Cult Of Good Blood, and may we all find it in abundance within ourselves!
© Dr. Rajas Deshpande

The group “LFU” also includes: Esha Agarwal, Shivkumar Thorat, Satyender, Tanvi Modi, Mayank Tripathi, Nikhil Nagpal, Sitanshu, Arvind Kumar, Nagesh Pimpre, all from the B. J. Medical College Pune.

PS: My heartfelt appeal to all medical students and doctors to contribute by starting similar activity in your region, by teaching poor students who want to become doctors, by joining this group and / or by donating for this cause.

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Which Is The Best Festival Upon Earth?

Which Is The Best Festival Upon Earth?
Dr. Rajas Deshpande

“Happy Diwali” said Mr. Abdul as he entered with a box of sweets in the OPD.

Over five years ago he was admitted with a complete paralysis, and had fully recovered as he had reached the hospital within two hours of the onset of paralysis. Since then I had received his Diwali hampers without fail.

A happy gentleman who liked to make funny sarcastic comments (maybe Pune effect), he made me smile every time. “Your fees has increased, doctor, but my feelings of gratitude for you will not change” he said now, silently laughing: “Every Diwali I remember that I was admitted on the Laxmipooja day, and our family was worried if the specialist doctors will be available. My wife was praying that there should be some specialist doctor to attend my case all the way from home when I became unconscious” he recalled. Dr. Rajas Deshpande

Indeed, he was admitted on the auspicious festival day, the junior resident doctor had activated the stroke code, our team had rushed in. I was already in the hospital to see a VIP leader whose headache usually worsened on holidays and then many specialists had to be called in to ego-massage his headache. So I could see Mr. Abdul immediately, and explained to his family that his condition was critical, that there were risks of complications in the first few days. Uncertain with the new doctor, they requested that I talked to their family physician Dr. Feroz. I did.
This is but natural, and there was no reason to feel offended with the anxieties of a serious patient’s family. In the age of trustless relationships where couples check each other’s cellphones like detectives and parents and kids question each other’s intentions, it is hardly possible that a serious patient’s family will blindly trust a new doctor. Even some doctors distrust new (not senior / junior, but the one being consulted for the first time) doctors. The only possible solution is an understanding doctor who takes this in stride, refuses to be offended, and acts in the best interest of the patient, taking an extra step to make the worried family comfortable. There are indeed some who never trust anyone whatever one does to satisfy them, but that is their own cross to carry, one should simply ignore the ugly trait. It is well known that those patients who do not trust any doctor suffer worst, as they don’t take anyone’s advice seriously. Dr. Rajas Deshpande

Three days later, as Mr. Abdul recovered, the family breathed in some confidence, and started believing all that I explained, without having to involve their family physician. Since then, although I have advised that he does not require to see me now, and instead he can follow up with Dr. Feroz, Mr. Abdul visits me every six months for a check up. His wife calls me Rajabhai, a name I would not have allowed anyone to call me with, but couldn’t dare tell this to her!

This is a pretty standard picture across India, most of even the poorest recover well from strokes, accidents, burns, infections, fractures, heart attacks and various other emergencies if they reach hospital in time. While people all over the world wish happy festivities to each other, take holidays, revel and eat and enjoy, while leaders give long festive speeches from their farmhouses to please various voters according to mob IQs, it is the professionals like doctors and servicemen like police, military, etc.who slog and run to save lives. They forget family and enjoyment to be available for those who suffer. The perpetual thankless will immediately say “but this is a choice you made”, but not understand that this choice was made to be respected, to earn well and to save lives, not for the society, the skimpsters and politicians to take advantage of. To see the sick and crying, angry people, to witness death and disability on the very days that your family expects you to be happy with them is not something one can easily come to terms to, and this is lifelong, not a five year term with long vacations. Dr. Rajas Deshpande

The fact that millions of critical patients are attended well during the most auspicious festivals: Diwali, Eid, Christmas, and all other religious festivals included, is conveniently forgotten once the festivals are over, and then the mudslinging about medical professionals starts, with the long speeches advising doctors to work harder with lesser expectations. Dr. Rajas Deshpande

“Doctor, this is not about Diwali or our religions” Mr. Abdul said while leaving, “this is to continue the tradition of humanity. There must be so many patients who can be with their families this festival, because some doctor worked hard to save them. This is my token of respect for those doctors”.

As always, I told Mr. Abdul that I was immensely grateful that the superpowers gave me this opportunity to be a doctor. I meant it. Dr. Rajas Deshpande

I often imagine: what if I was born with too much money, son of a rich father, with no worries for earning and no limits on spending, I would so much love to roam around the world in luxury cars and jets, among beautiful people (you understand), enjoying life to the brim, without caring for any suffering around me. In that case, I might have been very happy probably, but I won’t have respected myself as much. Even the most junior, newest recruit of a doctor is far superior to anyone who has chosen to cunningly ignore the suffering around, speaking big words and doing nothing about it.

Therein lies the best festivity in life: being a doctor, with an ability to abolish suffering and avert death.
Dr. Rajas Deshpande

Happy Diwali to all Patients, Medical Students, Junior and Senior Doctors, Resident Doctors, Nurses, Technicians and wardboys, Hospital staff and administrators, and to everyone who cares for others, showing it in their actions.

Advise Doctors What To Do?

 

For the hypocrites who don’t do anything to correct their own profession (almost every profession has immense corruption), but think they have the right to criticise other professions. Criticising the most intellectual profession of doctors irrespective of one’s own credibility, effort, contribution, or even intellect, has become an ugly fashion.
Here’s the answer:
(C) Dr. Rajas Deshpande

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The Silent Murders and Medical Suffocation

The Silent Murders and Medical Suffocation
© Dr. Rajas Deshpande

“Your grandfather is admitted and serious. Please come at once” my uncle said on the telephone.
I was in the first MBBS. This maternal grandfather was my closest relative after my father. An expert in many languages and philosophies, he was a constant source of love, wisdom and inspiration from my toddler days.

I submitted a leave application and travelled immediately to attend him. Grandpa was admitted in the general ward at the civil hospital Beed in Maharashtra. As the wards were full, he was kept with two other patients in a sort of a broad corridor, and IV antibiotics with saline were being given. He was delirious, but he managed to smile when he saw me. As civil hospitals do not have many medicines, my uncle arranged them from an outside pharmacy.

There was an elderly retired police inspector, Mr. Gaikwad, on the bed next to my Grandpa’s. He had uncontrolled sugar levels, and was slipping in and out of consciousness. His elderly wife was attending him, she was herself a patient of severe arthritis, and could not even get up or walk without excruciating pain. There were no chairs / stools or even mattresses for relatives attending the patients, so we slept on the floor besides our respective patients, upon our own bedsheets. I naturally attended the elderly couple too, I had enough time to attend humans as that was the pre cellphone era. Mrs. Gaikwad told me how her husband had spent his life without ever being corrupt, and said while she was proud that he was so clean, that also meant hardships like the one she faced. “Those who took bribes can afford to go to the private doctors in big cities and keep attendants. Our virtues translated in more hardships, the vocal rewards of words do not ease physical pain, nor pay any bills” she said with tears. © Dr. Rajas Deshpande

One night at about 3 AM, while I was deep asleep, I heard a scream and got up startled. Mr. Gaikwad was having a convulsion, and his wife shouted in panic. I ran to call the nurse, but there was only one for the entire ward and she was in the washroom. By the time she came out, the convulsion had stopped. She stopped the insulin drip and called the doctor on duty, who was asleep in the casualty. He came and administered some medicines and went away, exhausted. He was on duty for over three days in a row now, tired and irritable, yet had no option but to go on. I dozed off again. © Dr. Rajas Deshpande
In a few minutes, I realized Mrs. Gaikwad was waking me up again, shaking violently, because the IV needle of her husband had come out and he was bleeding. In panic I stood up. There was some water on the floor, and before I realized, I fell face down upon the bare floor. Such was the impact that my upper front tooth broke, and tore through my upper lip. It was bleeding profusely. The nurse had come and inserted another IV line to the patient by then, and the elderly lady felt quite guilty for my injury.

The nurse asked me to go to the casualty. The wardboy there refused at first to wake up the doctor on duty, saying he hadn’t slept for past two nights. However, as the bleeding continued, he took pity and woke up the doctor. Already angry, the casualty doc cleaned and sutured my lip with the available suture material, the correct one was not there. He asked me to get the painkillers and antibiotics from the pharmacy, and to fill up the necessary papers and pay the fees at the window.
With a swollen lip and an aching head, I returned to the ward and slept again. The next day, Grandpa was already feeling better, he could get a bed in a semi-private room, and discharged in two days after that.
Mr. Gaikwad, the elderly retired inspector passed away after two days, obviously a case of far less medical attention and facility. © Dr. Rajas Deshpande

I carry the scars till date.

Not much has changed in the civil / government run hospitals, even today. Far lesser beds and amenities, a constant lack of medicines and instruments, anarchic uncleanliness, underpaid and understaffed faculty, “sarkari” type procedural delays: overall a third-rate or worse experience in healthcare, with bribes and corruption at almost every level.
What is being projected is opposite though. The whole blame is being planted upon the medical professionals, and all the so-called reforms being made are just tightening of working conditions of the allopathic doctors. We do need reforms in medical malpractice and corruptions, and they are of course welcome, but many more thousand patients die due to apathy and lack of medicines and facilities at the government run hospitals than those who die due to medical malpractice. The number of administrators and government employees who do not attend government hospitals is a proof of the massive healthcare deficit we have everywhere in India. © Dr. Rajas Deshpande

Ambulances, thousands of more basic and specialty hospitals, more doctors, nurses, support staff in govt. run hospitals, better facilities and medicines are basic social requirements before any other development, advertisements or beautification is planned. However, the whole system appears to be concentrating upon the earning, eligibility and qualifications of existing allopaths.
MCI and IMA must also look into “Compulsory Basic Healthcare Facility and Patient Rights and Care” at all Civil / Govt. hospitals, specifying what the govt. must mandatorily implement in all its set-ups, what are the responsibilities of the administration. The overall (incorrect) notion that “All the problems in Indian Healthcare are because of the greed of Allopathic Doctors” is on the rise because of the “Govt. pleasing policies, comments and attitudes” by some. This will be extremely harmful in the long run. Progress can only be made in healthcare once the medical “Yes-Men” and “Yes-Women” are gone, once the voices that can boldly speak the truth are heard well.

Till then, the private practitioners must stay united in raising their voice against such “unilateral reforms” and defamation, or prepare to be forever suffocated by the system.

© Dr. Rajas Deshpande
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Homoglobin

Homoglobin

© Dr. Rajas Deshpande

“How much is your experience, doc? Have you ever seen any cases like this?” she asked. She was accompanying her father who had Parkinson’s Disease, quite common all over the world.

Many hilarious and abrasive retorts came to my mind:

‘Do you ask such questions about the pilot or driver when you board a plane or bus? , Do you ask such questions when someone absolutely inexperienced is made a minister of important portfolios like health, defence, environment etc.?’ If you can have faith in them, why cannot you trust your qualified doctor?© Dr. Rajas Deshpande

However, being on the doctor’s side of the table, I could not allow myself losing patience so easily. I chose the most professional answer, forcing a smile: “I am practicing since 25 years, over 15 as a Neurologist, and I have seen over two lac thirty thousand patients till now. Almost every Neurologist sees an average of 30-40 patients per day”.

When the rural / illiterate populace asks these questions innocently, I am never offended, but if it is the literate suspicious kind who treat manners and etiquette as an ‘optional’ part of communicating with the doctor, I feel just like when someone spills my ice-cream. It is difficult to connect with a paranoid literate, however hard one tries.

Apparently satisfied with my experience, she shot her next google bullet: “Can this happen because of his low Homoglobin? I read it on a blog.”

“The correct term is Hemoglobin”, I told her, “and its low level does not cause Parkinson’s”.

It was over 45 minutes since they entered, I had replied to every point on the question paper that they had prepared from a Googlesearch syllabus. The next patient must be already angry now, I thought.© Dr. Rajas Deshpande

“How can you be so sure that this is Parkinson’s Disease? What’s the proof?” Fired she.

“There are many diseases where there are no proofs of diagnosis, some can be proven, most are based upon the doctor’s clinical judgement. Sometimes quite costly tests are required to prove what is an obvious diagnosis. You are welcome to obtain a second opinion” I replied.

“Can his Parkinson’s be the side effect of the knee surgery done eight years ago?” She.

“No” me.

I now issued a DNR (Do Not Resuscitate) order for my gasping patience.

Most doctors know the simplified versions of how to explain the patient in layman language about the common diseases/ disorders. Every type of case requires a lot of reading and actual handling / treating to gain insights about that condition, something that is impossible to explain exactly to the patient / relative, especially because they do not know the basic concepts, organs, their functions etc. What even the brilliant medical students take repeated readings and many case studies to understand well, cannot be simplified enough to explain to all and sundry.© Dr. Rajas Deshpande

Add to this: every patient even with the same diagnosis is different, needs an individualised approach, and no google guidelines or statistics can replace the doctor’s wisdom in making a treatment decision especially in complicated cases. To make the most accurate decision and to explain it is a doctor’s duty, but the understanding quotient of the patient or relative cannot be the doctor’s responsibility. Medicine is so complicated, that even the most experienced doctor in the world cannot say he knows everything about any single medical condition.

The more you attempt to educate some literates, the deeper in a quicksand you enter. Because they are not satisfied with the fact that the doctor is making the best effort to educate, but look upon this as an opportunity to question the knowledge and wisdom of the very expert whose opinion they are there to seek!

They try and catch words and cross question as if it is a legal argument.

“You said swelling: show me where is the swelling?” most common question.

“Well, it is called Inflammation in medical language, there is no accurate translation for that word even in Hindi, hence we commonly use the word swelling. It may not be a visible swelling”.© Dr. Rajas Deshpande

It is not always the fault of doctor’s ability to communicate, it is often the over-expectation that one can understand everything. It is laughable that even those some whose life is a mess, who are failures in their own chosen paths try and argue about medical diagnosis and decisions with highly qualified doctors.

However profound a doctor I may think I am, there are so many things I do not understand: politics, finances, many people’s behaviour, mathematics, government, etc., and I am ok without ith not understanding most. However I do not have the audacity to ask an expert in these fields / professor / CA whether he / she has enough experience.

But with a doctor, these liberties are becoming rampant now.

“I think he has convulsions because of his spondylosis” one halfpant+crocs combo tried to punch a new hole in my knowledge recently.

“Let me decide that” was all I replied, rather than explaining how he was beyond wrong.

The shorter you keep it, the sweeter it remains. I would rather save and use my time for those worried, panicked patients who have enough faith in my abilities, who understand mutual respect, and who will have at least this insight: that the doctor knows best how to treat patients.© Dr. Rajas Deshpande

Of course I am aware that there are some doctors too, who initiate rude conversations, do not respect simple etiquettes, and are quite difficult to connect to. Most patients even when offended by rude doctors, kindly choose not to react although they carry home a bitter feeling. Every medical student, every doctor must be taught in the earliest parts of internship about the code of etiquette and mutual respect while dealing with any patient, and only then expect the patient to follow it too.

Coming back to this lady, I wrapped up the session by telling them to follow up after a month.

“Can he continue to take his three large pegs of rum every night? He cannot sleep otherwise” she asked.

“In my 25 years of practice, I haven’t met anyone whose health improved with alcohol. Do please google that.” I gave her the dose she had begged for.

© Dr. Rajas Deshpande

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Doctor’s Fees: A Taboo Topic

Doctor’s Fees: A Taboo Topic
© Dr. Rajas Deshpande
 
A famous industrialist from Pune recently visited my OPD. My Boss called me on phone and told me to waive off the fees, as he was a close friend of my Boss. The industrialist was not only well behaved, but well-read too. He had a complicated problem, had seen Neurologists etc. in India and UK. He asked many questions, and I was happy to have been able to reply to most. The consultation lasted over 45 minutes. He went out, and was told by the receptionist that his fees was waived off. He knocked my door, came back in, and placed three thousand rupees on my table. My usual fees is half that.
“Doc, I don’t believe in taking advantage. You gave me all the time I needed, and I have paid far more to the foreign doctors for a fraction of that time” he said.
 
Just a few days prior, a European patient from Mumbai had visited with her Indian in-laws, and after a detailed consultation, when they went out and paid the usual fees of 1500 INR, she messaged me: that this was far lower for the service they received. © Dr. Rajas Deshpande
 
Two days ago, on Saturday night at 9 PM, one lady rushed in without appointment, an engineer now working in Pune. Quite lavish in her get up and paraphernalia, she told me she had recently delivered a baby in the USA and then returned to India. After we finished the consultation that lasted over 30 minutes, and included many questions and explanations about her “minor” neurological problem, about justification of diagnosis, every medicine, about lactation, and about her prior medical consultations, I was happy that I had answered all her questions, and was able to treat her without any tests. Then she said: “And yes, doc, your fees is too high. Most doctors in my area charge less than that. I want concession”.
 
Earlier it was quite embarrassing for me to discuss money with patients. I felt it was below my dignity to have to talk about money, and humiliating to have to explain my fees. When I decided what I charged, it was after a prolonged thought process, and awareness of Indian healthcare scenario and socioeconomic conditions. While being available for genuinely poor patients, I did not want to resort to any backdoor incomes, and also wanted to give every patient the best of my skill acquired over 15 years of education, and enough time. There are clean doctors, far more senior than me, in my branch, who know this well and charge a lot more as consultation fees than I do (some over 5000 INR for a single consult), for they know their own worth. But there also are few who for their own reasons continue to charge far lesser, some with a noble intention (usually at the fag end of their career), some with alternative plans. It is a personal preference of the doctor, especially specialist. A correct diagnosis and honest /right advise is becoming rare and rare, what with the quality of medical education and an admixture of streams, which aim at the fast, cheap, objective and basic rather than specialized, subjective and accurate. © Dr. Rajas Deshpande
 
In absence of any comparable example, (medical service is not comparable to any other, but to quote an example that most should understand), I have to mention this: when one buys land, home, good food or technology, one pays differently at different places, for different brands. No one argues about the rates of foreign cellphones or jewelry, even about cinema tickets, but the most important service of all: health, is considered a bargainable, perpetually low cost charity. Basic and emergency healthcare doesn’t mean attached super-technology, five star rooms and washrooms and air conditioning, best qualified staff and ancillary services. © Dr. Rajas Deshpande
 
Used to this question very frequently, I told this lady that my fees was the same as that of most super-specialists in larger cities, that it was based upon qualification, experience, skill and time spent. She wouldn’t listen, and refused to pay. I told her she could avail of the free OPD meant for poor patients if she had a BPL card or if she was a farmer. “I can afford, I am not poor. But I want concession, because some doctors in my area charge only XXX”she said. © Dr. Rajas Deshpande
 
A senior doctor had advised me during the beginning of my practice: “Concentrate on the affordability of the middle class. Manage your time with the patient according to their affordability, people are rarely willing to pay the doctor. If your consultation fees is high, you will turn off many patients, because even the rich opt for the cheapest possible healthcare, including the doctor”. © Dr. Rajas Deshpande
 
Of course I did not want to discriminate. But over a period of time I realized that most of the forced free categories keep on repeatedly visiting various specialists / hospitals (a free category patient visits over three consultants for every medical issue) because it is free/ low cost, this is a frustrating scenario. Even the affording class visits many specialists for the same problem because the doctor’s fees is too ‘affordable’.
 
A doctor must always be kind and compassionate, but in India, he / she also needs to be practical to avoid being exploited. Compare to the availability of a free food service at your home for the poor. Check out for yourself how many misuse it, and how often. © Dr. Rajas Deshpande
 
Various pathies and specialties have a different fees structure, and people must be educated that all doctors cannot charge the same. A surgeon or physician with more skill, experience, expertise and good outcomes is definitely entitled to charge more than his peers. After all, what is a few thousand rupees when one’s health is concerned? When filing suits against doctors who commit mistakes, people claim in crores, a fact that must be accounted for when the doctor charges his / her fees.
 
“Your fees has increased” said a patient, who has paid the same fees for last 8 years. When I asked him to name any commodity whose price hasn’t increased in last eight years, he said “But you are a doctor”. © Dr. Rajas Deshpande
 
Among all the inflations happening everywhere, it is only the doctor’s fees that mostly remains unchanged for years. There are excellent charity institutes with great healthcare services , also many government hospitals, but most people want a “Premium / Priority” healthcare service at their lowest rates, refusing to stand in a queue at such hospitals. © Dr. Rajas Deshpande
 
The cut throat competition among hospitals to match society’s low cost healthcare expectations has resulted in a nightmare: most of the permanent staff being hired is low-salary, low qualification overworked, and exploited, many of the consumables used are of a questionable quality. This reflects worst in most critical care units and some surgical units. Very few will understand the true depth of this horrible tragedy.
 
While all cut-practice and other malpractices must end, while every doctor must compassionately aim at resolving the health problem that the patient trusts him / her with, and satisfy the patient as much as possible, it is also necessary that people understand that good healthcare will come at a higher cost. No doctor should refuse emergency /basic treatment to a patient who really cannot afford. Other than this, “Cheaper Doctors are the kindest and the best” is a devastating superstition we must eradicate.
 
© Dr. Rajas Deshpande
 
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